Provider Demographics
NPI:1417059106
Name:QUINTANA, MANUEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:R
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0406
Mailing Address - Fax:407-975-0407
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:FLORIDA HOSPITAL OB SPECIALISTS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0406
Practice Address - Fax:407-975-0407
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54991207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08920OtherBC/BS
FL035642500Medicaid
FL3872911OtherCIGNA
FL08920SMedicare PIN
FL3872911OtherCIGNA
FL08920OtherBC/BS
FL160033922OtherRAILROAD MEDICARE
FL035642500Medicaid